When should chemo be started in an asymptomatic patient who has a rising PSA where hormones have failed?

When should chemo be started in an asymptomatic patient who has a rising PSA where hormones have failed?

Dear OncoLink "Ask The Experts," When should chemo be started in an asymptomatic patient who has a rising PSA where hormones have failed?

David J Vaughn, MD, Medical Director of the Abramson Family Cancer Research Institute and Associate Professor of Medicine, Hematology-Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:

In general, chemotherapy is usually employed in the patient with metastatic disease with progression on hormones, with or without symptoms. In the non-metastatic asymptomatic castrate (achieved through orchiectomy or hormone therapy) patient who has biochemical progression (rise in PSA), the decision is more difficult. Alternate hormones such as anti-androgens and ketoconazole can be considered.

Chemotherapy could be used if one was concerned that the PSA progression was a sign of rapidly progressing subclinical metastatic disease that would cause symptoms in short order. Finally, this is an excellent patient situation for a clinical trial.